Does improved interpreter uptake reduce self-discharge rates in hospitalised patients? A successful hospital intervention explained

Abstract

Background: Aboriginal language interpreters are under-utilised in healthcare in northern Australia. Self-discharge from hospital is an adverse outcome occurring at high rates among Aboriginal people, with poor communication thought to be a contributor. We previously reported increased Aboriginal interpreter uptake and decreased rates of self-discharge during implementation of a 12-month hospital-based intervention. Interrupted time-series analysis showed sudden increase and up-trending improvement in interpreter use, and a corresponding decrease in self-discharge rates, during a 12-month intervention period (April 2018-March 2019) compared with a 24-month baseline period (April 2016 -March 2018). This paper aims to investigate reasons for these outcomes and explore a potential causal association between study activities and outcomes.

Methods: The study was implemented at the tertiary referral hospital in northern Australia. We used the Template for Intervention Description and Replication (TIDieR) as a framework to describe intervention components according to what, how, where, when, how much, tailoring, modifications and reach. Components of the study intervention were: employment of an Aboriginal Interpreter Coordinator, 'Working with Interpreters' training for healthcare providers, and championing of interpreter use by doctors. We evaluated the relative importance of intervention components according to TIDieR descriptors in relation to outcomes. Activities independent of the study that may have affected study findings were reviewed. The relationship between proportion of hospital separations among Aboriginal people ending in self-discharge and numbers of Aboriginal interpreter bookings made during April 2016-March 2019 was tested using linear regression. 'Working with Interpreters' training sessions were undertaken at a regional hospital as well as the tertiary hospital. Training evaluation comprised an anonymous online survey before the training, immediately after and then at six to eight months. Survey data from the sites were pooled for analysis.

Results: Employment of the Aboriginal Interpreter Coordinator was deemed the most important component of the intervention, based on reach compared to the other components, and timing of the changes in outcomes in relation to the employment period of the coordinator. There was an inverse association between interpreter bookings and self-discharge rate among Aboriginal inpatients throughout the baseline and intervention period (p = 0.02). This association, the timing of changes and assessment of intercurrent activities at the hospital indicated that the study intervention was likely to be casually related to the measured outcomes.

Conclusions: Communication in healthcare can be improved through targeted strategies, with associated improvements in patient outcomes. Health services with high interpreter needs would benefit from employing an interpreter coordinator.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Plot of raw data showing Aboriginal interpreter booking numbers made at royal Darwin hospital per quarter during the study baseline and intervention periods, annotated to show timing of intervention components.

Blue line: baseline period; red line: intervention period.

Fig 2. Self discharge rates among Aboriginal inpatients according to number of interpreter bookings made per quarter during baseline and study intervention period (April 2016 to March 2019).

Dashed line shows line of best fit. P value derived from linear regression analysis.